NPIMap

Organization Active NPI

Spencer Municipal Hospital

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Spirit Lake, IA
National Provider Identifier
1760479554
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
37H Issued in IA
Legal business name
SPENCER MUNICIPAL HOSPITAL
Practice address
3150 18TH St
Spirit Lake, IA 51360-7468
Phone
(712) 336-2910
Fax
(712) 336-4026
NPI assigned
Oct 5, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brenda Tiefenthaler
Title
Chief Executive Officer
Phone
(712) 264-6111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 37H IA Primary

Addresses

Primary practice location

3150 18TH St
Spirit Lake, IA 51360-7468

Mailing address

1200 1St Ave E
Spencer, IA 51301-4330
Phone (712) 264-6111

Other identifiers 1

IdentifierTypeStateIssuer
0601120MedicaidIA

Other names 1

  • Warner Dialysis Center- Spirit Lake Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051101000887 IA Part A Provider - End-Stage Renal Disease Facility (ESRD) 4183533060 Practice locations: Spirit Lake, IA

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Warner Dialysis CenterCCN 163513
Overall star rating
2.0 of 5
Ownership
Non-profit
Certified
Nov 15, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
12

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Internal Medicine Clini14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Practitioners & affiliated clinicians

Practitioners 95

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 95

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1760479554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 1ST AVE E",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513014330",
            "telephone_number": "712-264-6111",
            "fax_number": "712-264-6404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 18TH ST",
            "city": "SPIRIT LAKE",
            "state": "IA",
            "postal_code": "513607468",
            "telephone_number": "712-336-2910",
            "fax_number": "712-336-4026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPENCER MUNICIPAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "TIEFENTHALER",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "712-264-6111"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "IA",
            "license": "37H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0601120",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Warner Dialysis Center- Spirit Lake",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Warner Dialysis Center- Spirit Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spirit Lake, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.